"National Health Care Is Just Morally Right" -Beatrix Hoffman

As I’ve been reflecting on the themes I’ve been writing and posting about lately, I felt it was the right time to share a paper I wrote during my freshman year of college. This was an argumentative, research-based essay for a class where we were allowed to choose any topic—and I chose to write about the struggles within the U.S. healthcare system.

Ironically, or perhaps inevitably, I ended up spending a month in the hospital during that very semester due to a series of health complications and an unexpected surgery. I experienced firsthand the exact issues I was writing about, and I ultimately finished this paper from my hospital bed.

It’s personal, it’s researched, and it’s a snapshot of both my academic and lived experience. I hope you enjoy it!

It is a common experience for Americans to struggle to pay for their healthcare. Many people cannot afford insurance or make too much money to qualify for government support. Much of this can be attributed to the lack of universal healthcare and non-profit healthcare. This can easily be solved with a national healthcare program as proper healthcare for all Americans is only accessible outside of the profit system (Hoffman). 

American healthcare has operated under the profit system since before insurance companies were created. These companies started forming in the early 1930s and paid the hospital directly for any healthcare needs (Hoffman). At the time, these companies were functioning as non-profits. Blue Cross and Blue Shield were created around this time and caused hospital costs to rise (Hoffman). This cost inflation led to less accessibility of free healthcare and high out of pocket bills for many Americans. 

This growing cost prompted the government to create Medicare, a government funded healthcare plan for those over 65 based on the fee-for-service principle (Hoffman). This principle means that hospitals charge the government on the patient’s behalf after the services were performed. These charges were determined by the doctor and went directly into their pockets. This led to higher healthcare costs (over a 300% increase), not just for Medicare patients but for all Americans regardless of insurance or financial status (Hoffman). This meant that middle-class citizens had to pay the inflated prices caused by Medicare and other insurance programs. With this exorbitant charge, healthcare had cost the United States government $206 billion by 1978 (Hoffman). 

With the inflation of healthcare costs, many people could not and still cannot afford to pay for their insurance but make too much money to qualify for government-funded healthcare. For example, in 1998, the Congressional Budget Office estimated between 21 and 31 million people were uninsured for the entire year and another 60 million were uninsured for some part of the year (How many people lack health insurance and for how long). At this time, most people received their insurance coverage through their employer or a family member's employer so if they lost their job, even to health issues, they also lost their insurance coverage (How many people lack health insurance and for how long). Along with this, many people without insurance did not qualify for state or government-funded insurance because of strict means tests. One of the strictest is in Louisiana where the childless have to have a monthly income less than $174 to be eligible for state healthcare (Hoffman). 

The chronic lack of healthcare has greatly impacted the livelihood of Americans. In 1979, it was reported that 29 million Americans lacked healthcare and in 1992, that number grew to 37.1 million (Hoffman). On top of this, 51.3 Americans were without insurance at some point during the year but not the entire year (Hoffman). This issue was brought to light between 2000 and 2004 when the Institute of Medicine of the National Academy of Sciences released a report that Americans without insurance received about half as much healthcare in comparison with insured Americans (Hoffman). Based on this data, they were able to come to the conclusion that 18,000 Americans die every year due to a lack of health insurance (Hoffman). These Americans are less likely to receive preventative screenings and treatments leading to a higher rate of major diseases like cancer. 

One of the many problems with the cost of healthcare revolves around increased price and inflation. For example, in the past 20 years, the cost of United States hospital services has increased by over 200% while the average income has only increased by 60% (Patel). 

Frequently, the argument against universal or government funded healthcare is that it will put a strain on the current systems or cost too much. While this is a valid concern, multiple short term organizations have proved this wrong. For example, The Illumination Foundation supports the demographic of those experiencing homelessness by giving them access to primary healthcare. Ackerman-Barger et al. (2023) reports that in 2014 to 2019, within the demographic the Illumination Foundation was supporting, emergency room visits decreased by 22.2%, hospital admissions decreased by 26.3%, and primary care provider visits increased by 70%. Within this time, millions of dollars in healthcare-related costs were saved (Ackerman-Barger, Kupiri, et al.). Hoffman also touches on this subject when discussing the Emergency Maternal and Infant Care Act that was created in 1943. This act supported pregnant wives of service men and their infant children during World War 2. At the time it was the country's largest public health experiment and the first time the government took responsibility for civilian care (Hoffman). This was supported by most Americans. This plan of free healthcare for this demographic cut maternal mortality rates in half and infant mortality rates were cut by one third (Hoffman). Along with these two examples, many countries use a free national healthcare system that costs less than having private healthcare all the while having better medical results. In 2010, France was named the best health system in the world by the World Health Organization. France was able to spend less than $4,000 per person to cover all of their citizens' healthcare while in the same year, the United States spent $8,000 per person and 47 million citizens were left uninsured (Hoffman). These statistics greatly support that giving Americans access to free healthcare actually costs less money for the government and puts less strain on the healthcare system as citizens can receive primary and preventative care instead of overrunning urgent care and emergency facilities.  

To build on the differences between countries with free healthcare, the United States has extremely high medical costs yet the value of resources and outcomes are worse than other countries. In 2008, the United States spent twice what other countries did on healthcare costs and According to the Organisation for Economic Co-operation and Development, “U.S. prescription drug spending in 2015 was $1,162 per person on average, verses $807 for Canada, $766 for Germany, $668 for France, and is capped in the UK at £105.90($132)” (Roehr)(Wikipedia). This reflects just how much of a difference the cost is in peer countries. This high cost affects American behavior regarding healthcare such as how in 2010, 33% of Americans reported they went without needed care because of the cost and 35% were likely to have an out-of-pocket medical cost greater than $1,000 (Roehr). While these costs are so high, about one third of this medical spending is not associated with improved outcomes (“Why Does Health Care Cost so Much in America? Ask Harvard’s David Cutler.”). This is attributed to administrative costs being about 25% of healthcare costs since billing clerks need to process bills for different insurance companies (“Why Does Health Care Cost so Much in America? Ask Harvard’s David Cutler.”). This lack of transparency and accessibility via cost results in lifelong debt and loss of life for far too many Americans. 

In hopes to make healthcare costs more transparent, many people suggest having hospitals publish how much their procedures cost with each insurance company or out of pocket. Sarah Kliff, a writer for the New York Times, researched this and was able to find that “[a]t Aurora St. Luke’s in Milwaukee, an M.R.I. costs United enrollees $1,093 if they have United’s HMO plan and $4,029 if they have United’s PPO plan.” and that “[a]t the University of Mississippi Medical Center, a colonoscopy costs: $1,463 with a Cigna plan, $2,144 with an Aetna plan, and $782 with no insurance at all.”(Kliff, Sarah, et al.). Sadly this is not an uncommon experience at all. Jeanne Pinder was charged $1,419 for a generic anti-nausea drug she received during surgery that could be bought online for $2.49 (Pinder). Kliff and Pinder found that it can be cheaper to pay out of pocket than pay the insurance deductible for many medical procedures. They each started plans for getting this information to the general public so they can have all the information they need to choose how they want to pay. 

Another recommendation for how to control medical costs was given by Patel. He theorized that the government could make investments with independent care facilities, in-store clinics, and urgent care facilities to lower prices for many Americans (Patel). He suggested that Americans could pay extra or have their insurance pay if they wanted to go to a teaching hospital or an expensive facility that was not needed (Patel). 

One of the largest issues with healthcare in America is the cost, even for those with insurance. This is proved by the largest debt owed to collection agencies in America being unpaid medical bills (Patel). This not only affects those without insurance but also those with insurance plans. 16% of insured families have a debt owed because of medical expenses (Kliff, Sarah, et al.). In 2020, the total cost of medical bills owed was $140 billion (Patel). Frequently, these costs are a result of surprise bills, overcharges, or being charged out-of-network insurance prices even when you are in-network. After Jeanne Pinder’s case discussed above, she discovered that people were being charged different prices based on what hospital they went to and what insurance they had, in the same way doctors charged Medicare based on what they thought services should cost (Hoffman)(Pinder). Between this and what doctors could charge to insurance, healthcare prices skyrocketed and left lower-middle class families unable to afford healthcare out of pocket or an insurance plan (Hoffman). 

There has been a lot of effort made to develop insurance to protect the insurer rather than the insured (Hoffman). These efforts lead to health inequities based on finances and lead to loss of life, lower life expectancy, and a lower quality of life in the long run (Ackerman-Barger, Kupiri, et al.). These things are priceless and Americans are being denied them because of the government’s monetary greed. Major reform needs to take place within the American healthcare system before it is too late. 

Works Consulted

Ackerman-Barger, Kupiri, et al. “Call to action: Academic nursing’s role in redesigning health care to reduce the human and financial cost of health inequities.” Creative Nursing, vol. 29, no. 4, Nov. 2023, pp. 360–366, https://doi.org/10.1177/10784535231216466. [Refereed Journal]

Hixon, Todd. “Why Are U.S. Health Care Costs so High?” Forbes Magazine, 29 July 2012, www.forbes.com/sites/toddhixon/2012/03/01/why-are-u-s-health-care-costs-so-high/?sh=7f338a891dae [Unusual Source]

Hoffman, Beatrix R. Health care for some : rights and rationing in the United States since 1930. The University of Chicago Press, 2012, https://search.ebscohost.com/login.aspx?direct=true&db=cat00456a&AN=ua.3805032&site=eds-live&scope=site. [Print Book]

How many people lack health insurance and for how long. : A CBO paper. : CBO papers. Congress of the United States, Congressional Budget Office, 2003, https://search.ebscohost.com/login.aspx?direct=true&db=cat00456a&AN=ua.3826639&site=eds-live&scope=sitehttp://purl.access.gpo.gov/GPO/LPS31920. [Print Book]

Kliff, Sarah, et al. “Hospitals and Insurers Didn’t Want You to See These Prices. Here’s Why.” The New York Times, 22 Aug. 2021, www.nytimes.com/interactive/2021/08/22/upshot/hospital-prices.html. [Unusual Source]

Mathurin, Patrick. “US Healthcare Bankruptcies Soar as Costs Mount.” Financial Times, 2024, www.ft.com/content/65dfbc81-2641-48fa-a40a-647076943194. [Online Publication]

Patel, Nisarg. “Hospital Costs, Not Drug Prices, Are the Real US Healthcare Scandal.” Financial Times, 2021, www.ft.com/content/bdd8d490-bf92-445a-875f-a37d03314c07. [Online Publication]

​​Pinder, Jeanne. “What If All US Health Care Costs Were Transparent?” Jeanne Pinder: What If All US Health Care Costs Were Transparent? | TED Talk, 2018, www.ted.com/talks/jeanne_pinder_what_if_all_us_health_care_costs_were_transparent?language=en#. [Unusual Source]

Roehr, Bob. “US Healthcare Lags behind Other Nations despite Higher Costs.” BMJ: British Medical Journal, Vol. 341, No. 7783, 2010, www.jstor.org/stable/20800559. [Print Publication]

“Why Does Health Care Cost so Much in America? Ask Harvard’s David Cutler.” PBS, Public Broadcasting Service, 19 Nov. 2013, www.pbs.org/newshour/nation/why-does-health-care-cost-so-much-in-america-ask-harvards-david-cutler. [Interview]

Wikipedia contributors. "Health care prices in the United States." Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 3 Jan. 2024. Web. 5 Mar. 2024. [Wikipedia]

“With Health Care, Taxpayers Deserve to Know What They’re Paying For.” Forbes, Forbes Magazine, 19 Apr. 2011, www.forbes.com/2011/04/19/newt-gingrich-healthcare.html?sh=38b2ae69129f. [Unusual Source]